Barney’s VersionBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4561 (Published 25 August 2010) Cite this as: BMJ 2010;341:c4561
- Michelle Canavan, registrar, age related health care, Dublin,
- Desmond O’Neill, consultant in geriatric and stroke medicine, Dublin
Gertrude Stein wrote famously of her native Oakland that “there is no there there.” The general public, and many doctors and medical students, fear that the same might apply to life with dementia. One of the great challenges of teaching modern dementia care is to assert the vitality of life and life experience in illnesses such as dementia. Artists are often the storm troopers of consciousness, and the last novel of the great Canadian author Mordecai Richler gifts us with unique insights into life with dementia that could enhance any teaching programme related to the illness.
Barney’s Version is the story of the eponymous Barney Panofsky, a colourful character who has led an equally colourful life. Barney is a Jewish self-made millionaire who wishes to write his memoirs while he can still remember the details. He gives his version of events in a humorous, rambling, and at times combative style. The story is in three segments representing each of his three wives and is narrated in the first person.
From an early stage in the narration we notice that Barney has difficulty recalling certain words, names, and literary works. He is helpfully put to rights by his son, who corrects these mistakes by way of footnotes in the book. Although the alcohol doesn’t help Barney’s memory, he frequents his local tavern on a daily basis and continues to live life to the full despite his family’s disapproval that he does not conform to their visions as to how an “old” man should behave. As his dementia progresses, he insists on continuing to go to work, dictating often comical and nonsensical letters to his long suffering secretary and demanding they be sent regardless of the content or the range of the insults extended to the unfortunate recipient.
The short scene where Barney is finally persuaded to see a doctor and undergoes the mini-mental state examination provokes humour and discomfort and is a medical classic in its own right. It is not only entertaining but a reminder of the need for better training for people carrying out even simple cognitive screening. Barney admonishes the doctor for patronising him with ridiculous questions and counters each question with one of his own, all the while puffing on a cigar and uttering expletives in an attempt to mask what he knows are deficits in his memory. After his consultation he reads up about Alzheimer’s disease, then promptly calls a friend who is a doctor and asks him how long he has before he “goes gaga” and to set up an enduring power of attorney.
Barney copes with the diagnosis of his dementia with the humour, candour, and irreverent manner we have become accustomed to throughout the book, but the emotions experienced by his family are quite different. Barney’s daughter constantly pleads with him to come and live with her because she feels he is not capable of living alone.
The challenges to dignity in dementia are palpable in the description of a meal Barney has with his third ex-wife Miriam, where he has difficulty choosing from the menu and coordinating his cutlery and even forgets that they were no longer husband and wife. When it is decided that he should enter a nursing home, there is a huge sense of guilt, grief, and also relief.
This story combines wit, pathos, and individuality in its depiction of a man with dementia writing his life story. Although consistently entertaining (and at times hilarious), Barney’s Version is interspersed with the reality of the day to day battles that ensue when a person is struggling to deal with the onset of dementia.
Overall the book affirms how fullness of life can be enjoyed in the face of dementia and allows us to reflect on how we need to nuance and develop our own understanding of dementia and reconsider how we portray this condition to our patients and their families.
Cite this as: BMJ 2010;341:c4561
By Mordecai Richler
First published 1997